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  1. Article ; Online: Prevalence of cannabis use disorder and perioperative outcomes in adult colectomy patients: A propensity score-matched analysis.

    Lo, Brian D / Chen, Sophia Y / Stem, Miloslawa / Papanikolaou, Angelos / Gabre-Kidan, Alodia / Safar, Bashar / Efron, Jonathan E / Atallah, Chady

    World journal of surgery

    2024  Volume 48, Issue 3, Page(s) 701–712

    Abstract: Background: The decriminalization of cannabis across the United States has led to an increased number of patients reporting cannabis use prior to surgery. However, it is unknown whether preoperative cannabis use disorder (CUD) increases the risk of ... ...

    Abstract Background: The decriminalization of cannabis across the United States has led to an increased number of patients reporting cannabis use prior to surgery. However, it is unknown whether preoperative cannabis use disorder (CUD) increases the risk of postoperative complications among adult colectomy patients.
    Methods: Adult patients undergoing an elective colectomy were retrospectively analyzed from the National Inpatient Sample database (2004-2018). To control for potential confounders, patients with CUD, defined using ICD-9/10 codes, were propensity score matched to patients without CUD in a 1:1 ratio. The association between preoperative CUD and composite morbidity, the primary outcome of interest, was assessed. Subgroup analyses were performed after stratification by age (≥50 years).
    Results: Among 432,018 adult colectomy patients, 816 (0.19%) reported preoperative CUD. The prevalence of CUD increased nearly three-fold during the study period from 0.8/1000 patients in 2004 to 2.0/1000 patients in 2018 (P-trend<0.001). After propensity score matching, patients with CUD exhibited similar rates of composite morbidity (140 of 816; 17.2%) as those without CUD (151 of 816; 18.5%) (p = 0.477). Patients with CUD also had similar anastomotic leak rates (CUD: 5.64% vs. No CUD: 6.25%; p = 0.601), hospital lengths of stay (CUD: 5 days, IQR 4-7 vs. No CUD: 5 days, IQR 4-7) (p = 0.415), and hospital charges as those without CUD. Similar findings were seen among patients aged ≥50 years in the subgroup analysis.
    Conclusions: Though the prevalence of CUD has increased drastically over the past 15 years, preoperative CUD was not associated with an increased risk of composite morbidity among adult patients undergoing an elective colectomy.
    MeSH term(s) Adult ; Humans ; United States/epidemiology ; Prevalence ; Retrospective Studies ; Propensity Score ; Colectomy/adverse effects ; Marijuana Abuse/epidemiology
    Language English
    Publishing date 2024-02-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1002/wjs.12085
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  2. Article ; Online: Procedure-specific risks of robotic simultaneous resection of colorectal cancer and synchronous liver metastases.

    Radomski, Shannon N / Chen, Sophia Y / Stem, Miloslawa / Done, Joy Zhou / Atallah, Chady / Safar, Bashar / Efron, Jonathan E / Gabre-Kidan, Alodia

    Journal of robotic surgery

    2023  Volume 17, Issue 5, Page(s) 2555–2558

    Abstract: An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Although prior studies have reported that a simultaneous approach to resections in these patients ... ...

    Abstract An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Although prior studies have reported that a simultaneous approach to resections in these patients can lead to increased rates of complications, emerging literature shows that minimally invasive surgical (MIS) approaches can mitigate this additional morbidity. This is the first study utilizing a large national database to investigate colorectal and hepatic procedure-specific risks in robotic simultaneous resections for CRC and colorectal liver metastases (CRLM). Utilizing the ACS-NSQIP targeted colectomy, proctectomy, and hepatectomy files, 1,721 patients were identified who underwent simultaneous resections of CRC and CRLM from 2016 to 2021. Of these patients, 345 (20%) underwent resections by an MIS approach, defined as either laparoscopic (n = 266, 78%) or robotic (n = 79, 23%). Patients who underwent robotic resections had lower rates of ileus compared to those who had open surgeries. The robotic group had similar rates of 30-day anastomotic leak, bile leak, hepatic failure, and post-operative invasive hepatic procedures compared to both the open and laparoscopic groups. The rate of conversion to open (8% vs. 22%, p = 0.004) and median LOS (5 vs. 6 days, p = 0.022) was significantly lower for robotic compared to laparoscopic group. This study, which is the largest national cohort of simultaneous CRC and CRLM resections, supports the safety and potential benefits of a robotic approach in these patients.
    MeSH term(s) Humans ; Robotic Surgical Procedures/methods ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/pathology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Hepatectomy/adverse effects ; Hepatectomy/methods ; Liver Neoplasms/surgery ; Liver Neoplasms/secondary ; Colectomy/adverse effects ; Colectomy/methods ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2023-07-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-023-01659-y
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  3. Article ; Online: Factors associated with not undergoing surgery for locally advanced rectal cancers: An NCDB propensity-matched analysis.

    Chen, Sophia Y / Radomski, Shannon N / Stem, Miloslawa / Papanikolaou, Angelos / Gabre-Kidan, Alodia / Gearhart, Susan L / Efron, Jonathan E / Atallah, Chady

    Surgery

    2023  Volume 174, Issue 6, Page(s) 1323–1333

    Abstract: Background: The traditional treatment paradigm for patients with locally advanced rectal cancers has been neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. This study aimed to assess surgery trends for locally ... ...

    Abstract Background: The traditional treatment paradigm for patients with locally advanced rectal cancers has been neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. This study aimed to assess surgery trends for locally advanced rectal cancers, factors associated with forgoing surgery, and overall survival outcomes.
    Methods: Adults with locally advanced rectal cancers were retrospectively analyzed using the National Cancer Database (2004-2019). Propensity score matching was performed. Factors associated with not undergoing surgery were identified using multivariable logistic regression. Kaplan-Meier and log-rank tests were used for 5-year overall survival analysis, stratified by stage and treatment type.
    Results: A total of 72,653 patients were identified, with 64,396 (88.64%) patients undergoing neoadjuvant + surgery ± adjuvant therapy, 579 (0.80%) chemotherapy only, 916 (1.26%) radiation only, and 6,762 (9.31%) chemoradiation only. The proportion of patients who underwent surgery declined over the study period (95.61% in 2006 to 92.29% in 2019, P trend < .001), whereas the proportion of patients who refused surgery increased (1.45%-4.48%, P trend < .001). Factors associated with not undergoing surgery for locally advanced rectal cancers included older age, Black race (odds ratio 1.47, 95% CI 1.35-1.60, P < .001), higher Charlson-Deyo score (score ≥3: 1.79, 1.58-2.04, P < .001), stage II cancer (1.22, 1.17-1.28, P < .001), lower median household income, and non-private insurance. Neoadjuvant + surgery ± adjuvant therapy was associated with the best 5-year overall survival, regardless of stage, in unmatched and matched cohorts.
    Conclusion: Despite surgery remaining an integral component in the management of locally advanced rectal cancers, there is a concerning decline in guideline-concordant surgical care for rectal cancer in the United States, with evidence of persistent socioeconomic disparities. Providers should seek to understand patient perspectives/barriers and guide them toward surgery if appropriate candidates. Continued standardization, implementation, and evaluation of rectal cancer care through national accreditation programs are necessary to ensure that all patients receive optimal treatment.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Neoplasms, Second Primary ; Rectal Neoplasms/surgery ; Combined Modality Therapy ; Neoadjuvant Therapy ; Adjuvants, Immunologic
    Chemical Substances Adjuvants, Immunologic
    Language English
    Publishing date 2023-10-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2023.09.005
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  4. Article: Procedure-Specific Risks of Robotic Simultaneous Resection of Colorectal Cancer and Synchronous Liver Metastases.

    Radomski, Shannon N / Chen, Sophia Y / Stem, Miloslawa / Done, Joy Zhou / Atallah, Chady / Safar, Bashar / Efron, Jonathan E / Gabre-Kidan, Alodia

    Research square

    2023  

    Abstract: An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Controversy exists regarding the safety of a simultaneous versus staged approach to resections in ... ...

    Abstract An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Controversy exists regarding the safety of a simultaneous versus staged approach to resections in these patients, but reports have shown that minimally invasive surgery (MIS) approaches can mitigate morbidity. This is the first study utilizing a large national database to investigate colorectal and hepatic procedure-specific risks in robotic simultaneous resections for CRC and colorectal liver metastases (CRLM). Utilizing the ACS-NSQIP targeted colectomy, proctectomy, and hepatectomy files, 1,550 patients were identified who underwent simultaneous resections of CRC and CRLM from 2016-2020. Of these patients, 311 (20%) underwent resections by an MIS approach, defined as an either laparoscopic (n = 241, 78%) or robotic (n = 70, 23%). Patients who underwent robotic resections had lower rates of ileus compared to those who had an open surgery. The robotic group had similar rates of 30-day anastomotic leak, bile leak, hepatic failure, and post operative invasive hepatic procedures compared to both the open and laparoscopic groups. The rate of conversion to open was significantly lower for robotic compared to laparoscopic group (9% vs. 22%, p = 0.012). This report is the largest study to date of robotic simultaneous CRC and CRLM resections reported in the literature and supports the safety and potential benefits of this approach.
    Language English
    Publishing date 2023-05-16
    Publishing country United States
    Document type Preprint
    DOI 10.21203/rs.3.rs-2920026/v1
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  5. Article ; Online: Colorectal Surgery Outcomes in the United States During the COVID-19 Pandemic.

    Chen, Sophia Y / Radomski, Shannon N / Stem, Miloslawa / Papanikolaou, Angelos / Gabre-Kidan, Alodia / Atallah, Chady / Efron, Jonathan E / Safar, Bashar

    The Journal of surgical research

    2023  Volume 287, Page(s) 95–106

    Abstract: Introduction: The purpose of this study was to assess colorectal surgery outcomes, discharge destination, and readmission in the United States during the COVID-19 pandemic.: Methods: Adult colorectal surgery patients in the American College of ... ...

    Abstract Introduction: The purpose of this study was to assess colorectal surgery outcomes, discharge destination, and readmission in the United States during the COVID-19 pandemic.
    Methods: Adult colorectal surgery patients in the American College of Surgeons National Surgical Quality Improvement Program database (2019-2020) and its colectomy and proctectomy procedure-targeted files were included. The prepandemic time period was defined from April 1, 2019 to December 31, 2019. The pandemic time period was defined from April 1, 2020 to December 31, 2020 in quarterly intervals (Q2 April-June; Q3 July-September; Q4 October-December). Factors associated with morbidity and in-hospital mortality were assessed using multivariable logistic regression.
    Results: Among 62,393 patients, 34,810 patients (55.8%) underwent colorectal surgery prepandemic and 27,583 (44.2%) during the pandemic. Patients who had surgery during the pandemic had higher American Society of Anesthesiologists class and presented more frequently with dependent functional status. The proportion of emergent surgeries increased (12.7% prepandemic versus 15.2% pandemic, P < 0.001), with less laparoscopic cases (54.0% versus 51.0%, P < 0.001). Higher rates of morbidity with a greater proportion of discharges to home and lesser proportion of discharges to skilled care facilities were observed with no considerable differences in length of stay or worsening readmission rates. Multivariable analysis demonstrated increased odds of overall and serious morbidity and in-hospital mortality, during Q3 and/or Q4 of the 2020 pandemic.
    Conclusions: Differences in hospital presentation, inpatient care, and discharge disposition of colorectal surgery patients were observed during the COVID-19 pandemic. Pandemic responses should emphasize balancing resource allocation, educating patients and providers on timely medical workup and management, and optimizing discharge coordination pathways.
    MeSH term(s) Adult ; Humans ; United States/epidemiology ; Pandemics ; Colorectal Surgery ; COVID-19/epidemiology ; Hospitalization ; Patient Discharge ; Retrospective Studies ; Patient Readmission ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors
    Language English
    Publishing date 2023-01-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.12.041
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    Zs.A 178: Show issues Location:
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  6. Article ; Online: Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer.

    Liu, I-Chia / Gearhart, Susan / Ke, Suqi / Hu, Chen / Chung, Haniee / Efron, Jonathan / Gabre-Kidan, Alodia / Najjar, Peter / Atallah, Chady / Safar, Bashar / Christenson, Eric S / Azad, Nilofer S / Lee, Valerie / Zaheer, Atif / Birkness-Gartman, Jacqueline E / Reddy, Abhinav V / Narang, Amol K / Meyer, Jeffrey

    Surgery open science

    2024  Volume 18, Page(s) 42–49

    Abstract: Background: Total neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. ... ...

    Abstract Background: Total neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. However, questions remain regarding surgical outcomes and local control in patients who proceed to surgery, particularly when radiation is given first in the neoadjuvant sequence. We report on our institution's experience with patients who underwent short-course radiation therapy, consolidation chemotherapy, and surgery.
    Methods: We retrospectively reviewed surgical specimen outcomes, postoperative complications, and local/pelvic control in a large cohort of patients with LARC who underwent neoadjuvant therapy incorporating upfront short-course radiation therapy followed by consolidation chemotherapy.
    Results: In our cohort of 83 patients who proceeded to surgery, a complete/near-complete mesorectal specimen was achieved in 90 % of patients. This outcome was not associated with the time interval from completion of radiation to surgery. Postoperative complications were acceptably low. Local control at two years was 93.4 % for all patients- 97.6 % for those with low-risk disease and 90.4 % for high-risk disease.
    Conclusion: Upfront short-course radiation therapy and consolidation chemotherapy is an effective treatment course. Extended interval from completion of short-course radiation therapy did not impact surgical specimen quality.
    Language English
    Publishing date 2024-01-23
    Publishing country United States
    Document type Journal Article
    ISSN 2589-8450
    ISSN (online) 2589-8450
    DOI 10.1016/j.sopen.2024.01.015
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  7. Article ; Online: Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older.

    Owodunni, Oluwafemi P / Mostales, Joshua C / Qin, Caroline Xu / Gabre-Kidan, Alodia / Magnuson, Thomas / Gearhart, Susan L

    Journal of the American College of Surgeons

    2020  Volume 232, Issue 4, Page(s) 387–395

    Abstract: Background: Preoperative discussions around postoperative discharge planning have been amplified by the COVID pandemic. We wished to determine whether our preoperative frailty screen would predict postoperative loss of independence (LOI).: Study ... ...

    Abstract Background: Preoperative discussions around postoperative discharge planning have been amplified by the COVID pandemic. We wished to determine whether our preoperative frailty screen would predict postoperative loss of independence (LOI).
    Study design: This single-institutional study included demographic, procedural, and outcomes data from patients 65 years or older who underwent frailty screening before a surgical procedure. Frailty was assessed using the Edmonton Frail Scale. The Operative Severity Score was used to categorize procedures. The Hierarchical Condition Category risk-adjustment score, as calculated by the Centers for Medicare and Medicaid Services, was included. LOI was defined as an increase in support outside of the home after discharge. Univariable, multivariable logistic regressions, and adjusted postestimation analyses for predictive probabilities of best fit were performed.
    Results: Five hundred and thirty-five patients met inclusion criteria and LOI was seen in 38 patients (7%). Patients with LOI were older, had a lower BMI, a higher Edmonton Frail Scale score (7 vs 3.0; p < 0.001), and a higher Hierarchical Condition Category score than patients without LOI. Being frail and undergoing a procedure with an Operative Severity Score of 3 or higher was independently associated with an increased risk of LOI. In addition, social dependency, depression, and limited mobility were associated with an increased risk for LOI. On multivariable modeling, frailty status, undergoing an operation with an Operative Severity Score of 3 or higher, and having a Hierarchical Condition Category score ≥1 were the most predictive of LOI (odds ratio 12.72; 95% CI, 12.04 to 13.44; p < 0.001). In addition, self-reported depression, weight loss, and limited mobility were associated with a nearly 11-fold increased risk of postoperative LOI.
    Conclusions: This study was novel, as it identified clear, generalizable risk factors for LOI. In addition, our findings support the implementation of preoperative assessments to aid in care coordination and provide specific targets for intervention.
    MeSH term(s) Age Factors ; Aged ; Aged, 80 and over ; Elective Surgical Procedures/adverse effects ; Female ; Frailty/diagnosis ; Frailty/epidemiology ; Functional Status ; Geriatric Assessment/statistics & numerical data ; Hospital Mortality ; Humans ; Length of Stay ; Male ; Patient Discharge/statistics & numerical data ; Postoperative Period ; Preoperative Care/methods ; Risk Assessment/methods ; Risk Factors
    Language English
    Publishing date 2020-12-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2020.11.026
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    Uk I Zs.61: Show issues Location:
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  8. Article ; Online: Outcomes for Ulcerative Colitis With Delayed Emergency Colectomy Are Worse When Controlling for Preoperative Risk Factors.

    Leeds, Ira L / Sundel, Margaret H / Gabre-Kidan, Alodia / Safar, Bashar / Truta, Brindusa / Efron, Jonathan E / Fang, Sandy H

    Diseases of the colon and rectum

    2018  Volume 62, Issue 5, Page(s) 600–607

    Abstract: Background: Increasing evidence supports immediate colectomy in acute fulminant ulcerative colitis in comparison with ongoing medical management. Prior studies have been limited to inpatient-only administrative data sets or single-institution ... ...

    Abstract Background: Increasing evidence supports immediate colectomy in acute fulminant ulcerative colitis in comparison with ongoing medical management. Prior studies have been limited to inpatient-only administrative data sets or single-institution experiences.
    Objective: The purpose of this study was to compare outcomes of early versus delayed emergency colectomy in patients admitted with ulcerative colitis flares while controlling for known preoperative risks and acuity.
    Design: This is a cohort study of patients undergoing emergent total abdominal colectomies for ulcerative colitis compared by the timing of surgery.
    Setting: Adult patients undergoing an emergent total abdominal colectomy for ulcerative colitis, 2005 to 2015, were identified in the American College of Surgeons National Surgical Quality Improvement Program database.
    Patients: Patients undergoing total abdominal colectomy with an operative indication of ulcerative colitis admitted on a nonelective basis were selected.
    Main outcome measure: The primary outcomes measured were 30-day National Surgical Quality Improvement Program-reported mortality and postoperative complications, and early operation within 2 days of admission.
    Results: We identified 573 total abdominal colectomies after propensity score matching. Median time to surgery was 1 hospital day in the early group versus 6 hospital days in the delayed group (p < 0.001). Early operation was associated with a lower mortality rate (4.9% versus 20.3% in matched groups, p < 0.001) and lower complication rate (64.5% versus 72.0%, p = 0.052). Multivariable logistic regression with propensity weighting of mortality on preoperative risk factors demonstrated that early surgery is associated with an 82% decrease in the odds of death compared with delayed surgery (p < 0.001). Regression of morbidity on preoperative risk factors demonstrated that early surgery is associated with a 35% decrease in the odds of a complication with delayed surgery (p = 0.034).
    Limitations: Quality improvement data were used for clinical research questions.
    Conclusions: Patients undergoing immediate surgical intervention for acute ulcerative colitis have decreased postoperative complications and mortality rates. Rapid and early transitioning from medical to surgical management may benefit those expected to require surgery on the same admission. See Video Abstract at http://links.lww.com/DCR/A800.
    MeSH term(s) Acute Disease ; Aged ; Aged, 80 and over ; Cohort Studies ; Colectomy/methods ; Colitis, Ulcerative/surgery ; Databases, Factual ; Emergencies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; Odds Ratio ; Postoperative Complications/epidemiology ; Risk Factors ; Symptom Flare Up ; Time Factors ; Time-to-Treatment/statistics & numerical data
    Language English
    Publishing date 2018-11-28
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Video-Audio Media
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000001276
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  9. Article ; Online: Risk of readmission after laparoscopic vs. open colorectal surgery.

    Esemuede, Iyare O / Gabre-Kidan, Alodia / Fowler, Dennis L / Kiran, Ravi P

    International journal of colorectal disease

    2015  Volume 30, Issue 11, Page(s) 1489–1494

    Abstract: Purpose: Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well ... ...

    Abstract Purpose: Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well characterized. The aim of this study is to compare the risk of readmission after the two procedures in a large, nationally representative sample.
    Methods: Patients who underwent colorectal resection in 2011 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. LC and OC patients were compared for patient factors, complications, and readmission rates. A multivariable analysis controlling for significant factors was performed to evaluate factors associated with readmission.
    Results: Of 30,428 patients who underwent colorectal resection, 40.2% underwent LC. Length of stay (LOS) after LC was shorter than after OC (5.7 vs. 9.7 days, p < 0.001). LC was associated with a significantly lower rate of surgical site infections (SSI), bleeding, reoperation, 30-day mortality, and complications. Risk of readmission was greater for patients undergoing proctectomy than colectomy (12.7 vs. 10.6 %, p < 0.001), but was lower after laparoscopic than open for both procedures after controlling for confounding factors. Obesity, DM, operating time ≥180 min, steroid use, and ASA class 3-5 were found to be associated with readmission.
    Conclusion: Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.
    MeSH term(s) Aged ; Colectomy/adverse effects ; Colectomy/methods ; Colectomy/mortality ; Colonic Diseases/surgery ; Female ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Laparoscopy/mortality ; Male ; Patient Readmission ; Postoperative Hemorrhage/etiology ; Rectal Diseases/surgery ; Regression Analysis ; Risk Factors ; Surgical Wound Dehiscence/etiology ; Surgical Wound Infection/etiology
    Language English
    Publishing date 2015-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-015-2349-9
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  10. Article ; Online: Seasonal and day of the week variations of perforated appendicitis in US children.

    Deng, Yi / Chang, David C / Zhang, Yiyi / Webb, Jennifer / Gabre-Kidan, Alodia / Abdullah, Fizan

    Pediatric surgery international

    2010  Volume 26, Issue 7, Page(s) 691–696

    Abstract: Purpose: The present study aimed to determine whether children with perforated appendicitis were more likely to present during specific days of the week or seasons of the year.: Methods: After obtaining IRB exemption, a retrospective, population- ... ...

    Abstract Purpose: The present study aimed to determine whether children with perforated appendicitis were more likely to present during specific days of the week or seasons of the year.
    Methods: After obtaining IRB exemption, a retrospective, population-based study of patients <18 with ICD9 codes of acute (540.9) or perforated (540.0, 540.1) appendicitis in the Kids' Inpatient Database (KID) was performed. Univariate and multivariate analyses were performed analyzing patient and hospital factors.
    Results: A total of 31,457 children were identified with acute appendicitis, of whom 10,524 (33.5%) were perforated. Mondays [odds ratio (OR): 1.16; 95% Confidence Interval (CI): 1.05-1.28] were significant for increased likelihood as day of presentation with perforation in US children more than any other day of the week. In seasonal analysis, fall (OR: 1.12; 95% CI: 1.04-1.21) and winter (OR: 1.11; 95% CI: 1.03-1.20) were at higher odds for perforation at presentation. Patients with Medicaid (OR: 1.22; 95% CI: 1.03-1.43) and those uninsured (OR: 1.50; 95% CI: 1.16-1.93) were more likely to present with perforation.
    Conclusion: Perforated appendicitis was more likely to present on Mondays in US children. Although appendicitis is most common in summer months, rates of perforated appendicitis were highest in fall and winter.
    MeSH term(s) Acute Disease ; Appendicitis/epidemiology ; Child ; Female ; Humans ; Male ; Multivariate Analysis ; Odds Ratio ; Periodicity ; Retrospective Studies ; Seasons ; United States/epidemiology
    Language English
    Publishing date 2010-06-04
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632773-4
    ISSN 1437-9813 ; 0179-0358
    ISSN (online) 1437-9813
    ISSN 0179-0358
    DOI 10.1007/s00383-010-2628-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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